Sources: International Verapamil-Trandlapril Study (“INVEST”); American Journal of Medicine.

It does according to recent analysis from the International Verapamil-Trandlapril Study. The review related to older patients with hypertension and coronary artery disease who use nonsteroidal anti-inflammatory drugs (NSAIDs) chronically for pain.  The results suggest that they are at significantly increased risk of cardiovascular events.

“We found a significant increase in adverse cardiovascular outcomes, primary driven by an increase in cardiovascular mortality,” according to the article’s primary author Dr. Anthony Bavry  who observes, “This is not the first study to show there is potential harm with these agents.”

While the study did not differentiate among those taking  ibuprofen, naproxen, or celecoxib, a composite of all-cause death, nonfatal MI, or nonfatal stroke–occurred at a rate of 4.4 events per 100 patient-years in the chronic-NSAID group vs 3.7 events per 100 patient-years in the non-chronic group.  The report found that the risk of death from cardiovascular causes was more than doubled in the chronic-NSAID group compared with never or infrequent users.

According to Bavry, “When I see patients like these taking NSAIDs I will have an informed discussion with them and tell them there is evidence that these agents may be associated with harm. I try to get them to switch to an alternative agent, such as acetaminophen.”

The authors point to a recent American Geriatrics Society panel on the treatment of chronic pain in the elderly which recommends acetaminophen as a first-line agent and suggests that non-selective NSAIDs or COX-2 inhibitors be used only with extreme caution. “Our findings support this recommendation,” they state.

Bavry adds, “We do need more studies to further characterize the risks of these agents, which are widely used and widely available, and perhaps the risks are under-appreciated. We are working on the next level of studies to try to identify which are the most harmful agents.”

Post: Gayle R. Lewis, Esquire